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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486803228
Report Date: 08/11/2020
Date Signed: 08/12/2020 12:54:13 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME:CRESTWOOD HOPE CENTERFACILITY NUMBER:
486803228
ADMINISTRATOR:BUNGGAY, LUZVIMINDAFACILITY TYPE:
740
ADDRESS:115 ODDSTAD DRIVETELEPHONE:
(707) 552-0215
CITY:VALLEJOSTATE: CAZIP CODE:
94589
CAPACITY:24CENSUS: 21DATE:
08/11/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Campus Administrator, Lance Woodson and Service Coordinator Danvie Cardano TIME COMPLETED:
04:00 PM
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Licensing Program Analyst Willis met with Campus Administrator, Lance Woodson and Service Coordinator Danvie Cardano via teleconference in order to conduct a Case Management inspection.

LPA is following up regarding a fire that happened at the facility on 8/7/2020. Per conversation with Campus Administrator and Service Coordinator, staff observed smoke and melting plastic coming from an air vent in a client bathroom. Clients were not in the bedroom or bathroom when smoke was observed. Facility was evacuated for approximately 45 minutes while the Vallejo Fire Department inspected the roof and ceiling and smoke was cleared from the facility. Per Campus Administrator, there was no damage to the roof or ceiling and all the damage was contained within the ceiling vent housing, vent cover and toilet seat.

Service Coordinator conducted a walk through so LPA could make observations. Based on conversation with Campus Administrator and observations, the vent cover that had melted was replaced, ceiling was painted and the toilet seat which also partially melted was replaced. All repairs were completed the same day as the fire.

No deficiencies cited during this inspection.
SUPERVISOR'S NAME: Hope DeBenedettiTELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Victoria WillisTELEPHONE: (707) 588-5087
LICENSING EVALUATOR SIGNATURE:

DATE: 08/11/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
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